Journal of Ophthalmic and Optometric Sciences

Purpose: Out-of-pocket (OOP) expenses are a major factor influencing patients’ decisions to undergo refractive eye surgery. This study aimed to identify the factors associated with OOP payments for refractive surgery in selected medical centers in Tehran, Iran.
Patients and Methods: In this cross-sectional study, 200 adults undergoing refractive surgery (LASIK, LASEK, or PRK) were recruited through cluster sampling from state and private hospitals in Tehran Surgery Centers in 2025. Data were collected using a contingent valuation questionnaire to estimate patients’ maximum OOP payments. Factors influencing OOP costs were analyzed using ANOVA and independent t-tests.
Results: The mean OOP payments were 9,826,531 Rials (US$106) in state teaching hospitals, 26,387,097 Rials (US$284) in state non-teaching hospitals, and 74,380,282 Rials (US$800) in private hospitals. OOP costs were significantly associated with hospital type, age, marital status, length of hospitalization, type of insurance and supplementary insurance (P < 0.05).
Conclusion: OOP expenses for refractive surgery were substantially lower in governmental hospitals compared to private hospitals. Introducing multi-tiered insurance packages tailored to patient characteristics could improve access and reduce the financial burden of refractive surgery.

Purpose: To evaluate the demographic and clinical characteristics of juvenile open-angle glaucoma (JOAG) patients presenting to a tertiary eye care center in northern India.
Patients and Methods: We conducted a retrospective review of medical records of patients aged 5–35 years diagnosed with JOAG. Data collected included age, sex, family history, refractive error, best-corrected visual acuity, intraocular pressure (IOP), cup-to-disc ratio, optic disc changes, retinal nerve fiber layer findings, and visual field indices. Treatment status, prior surgeries, and associations with systemic illness were also analyzed.
Results: A total of 79 patients (158 eyes) were included. The majority was male, and most cases were bilateral. Myopia was the predominant refractive error. At presentation, many patients had advanced optic disc cupping and significant visual field loss, often despite ongoing anti-glaucoma medication. Mean IOP was markedly elevated, and several eyes had undergone prior trabeculectomy. Family history of glaucoma was noted in a subset of patients. Systemic comorbidities were infrequent.
Conclusion: JOAG in this cohort predominantly affected young males and was strongly associated with myopia and advanced disease at presentation. The findings highlight the aggressive nature of JOAG and the need for early diagnosis, vigilant screening of at-risk individuals, and timely surgical intervention to prevent irreversible visual disability.

Objective: To determine the prevalence of color vision disorders and dry eye in patients with cancer.
Patients and Methods: This cross-sectional study was conducted in 2019 at Imam Hossein Hospital, Tehran, Iran, and included 307 eyes from 165 patients with cancer before initiation of systemic chemotherapy. All participants underwent Schirmer I testing, binocular vision and ocular motility assessment, and color vision evaluation with Ishihara plates and the Farnsworth D15 panel. Posterior and anterior segment examinations were also performed.
Results: Data from 307 eyes of 165 patients were analyzed. The mean age was 54.26 ± 13.39 years (range, 18–86). Overall, 74.6 % of eyes showed some degree of dry eye. The mean Schirmer value was 8.65 ± 8.69 mm. Abnormal color vision was detected in 6.74 % of eyes by Ishihara and in 17.28 % by the D15 test. Exophoria was present in 58.8 % of patients and esophoria in 29.1 %, while 2.1 % demonstrated abnormal ocular motility.
Conclusion: Dry eye, color vision deficiency and heterophoria were more frequent among patients with cancer than in the general population, underscoring the need for routine ophthalmic screening and follow-up in oncologic care.

Purpose: To investigate the association between central retinal vein occlusion (CRVO) and the presence of mental health disorders.
Patients and Methods: This observational study included 120 patients with CRVO, aged 48–82 years. Psychiatric assessment was performed using standardized tools, including the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI), to evaluate the prevalence of depression, anxiety, and related mental health disorders.
Results: Of the 120 patients, 71 (59.16 %) were diagnosed with mental health disorders, most commonly depression and anxiety. The findings indicate that more than half of patients with CRVO experience significant psychiatric comorbidities.
Conclusion: Mental health disorders, particularly depression and anxiety, are highly prevalent in patients with CRVO. These results underscore the need for routine psychiatric evaluation and integrated care strategies to improve overall outcomes in affected individuals.

Purpose: To synthesize evidence on risk factors and interventions for slowing myopia progression in children and adolescents.
Methods: PubMed, Scopus, Embase, and Web of Science were searched through December 2023. Eligible studies included randomized and observational designs evaluating environmental factors, specialized spectacle lenses (defocus incorporated multiple segments [DIMS], highly aspherical lens [HAL], slightly aspherical lens [SAL]), multifocal or dual-focus soft contact lenses, orthokeratology, low-dose atropine, and repeated low-level red-light therapy. Two reviewers independently screened and extracted data. Risk of bias was assessed with Cochrane RoB 2 for randomized trials and the Newcastle–Ottawa Scale for observational studies. Outcomes were annual change in spherical equivalent refraction (diopters/year) and axial length (millimeters/year).
Results: Increased outdoor time was consistently associated with reduced incidence and slower progression. Specialized spectacle lenses (DIMS, HAL, SAL) and dual-focus/multifocal soft contact lenses slowed refractive change and axial elongation compared with single-vision controls. Orthokeratology effectively reduced axial elongation in appropriately selected eyes. Low-dose atropine produced dose-dependent benefits, with 0.05% generally more effective than 0.01%; rebound varied with dose, treatment duration, and tapering. Emerging evidence for red-light therapy suggested short-term efficacy, but long-term safety and rebound remain uncertain. Combination strategies, such as atropine plus optical interventions, showed additive effects, though data are limited.
Conclusions: Outdoor exposure, low-dose atropine (≈0.05%), DIMS/HAL/SAL spectacle lenses, multifocal or dual-focus soft contact lenses, and orthokeratology show the strongest evidence for slowing childhood myopia. Combination therapy may enhance outcomes, while red-light therapy remains promising but investigational, with long-term safety and rebound still uncertain.

Purpose: To systematically review the available evidence on the role of vision therapy in presbyopia management.
Materials and Methods: A systematic search was conducted in PubMed, Google Scholar, Cochrane Library, and Wiley for studies published between 1990 and 2024. Eligible studies assessed the effects of vision therapy, accommodative training, orthoptic exercises, or perceptual learning on presbyopic patients. Data on visual acuity, accommodative amplitude and facility, pupil size, patient satisfaction with near vision, and outcomes of eye exercises were extracted.
Results: From 87,404 initial records, 325 articles were screened, and 7 studies met inclusion criteria. These studies demonstrated that vision therapy may improve accommodative amplitude, near visual acuity, accommodative facility, and patient satisfaction. However, the evidence is limited by small sample sizes, heterogeneous methodologies, and short follow-up periods, which restrict generalizability.
Conclusion: Vision therapy shows potential as a non-invasive adjunct for presbyopia management, but current evidence is insufficient for definitive recommendations. Well-designed randomized controlled trials with standardized protocols are needed to establish its clinical efficacy and long-term outcomes.

Intragastric botulinum toxin A is increasingly used as an endoscopic adjunct for weight reduction, and although generally safe, rare neurological and ophthalmic adverse effects have been reported. We describe the case of a 37-year-old woman who developed dimming of vision in the left eye twelve days after intragastric botulinum toxin A injection. Visual evoked potential revealed delayed P100 latency in the affected eye, while the contralateral eye was normal, and magnetic resonance imaging demonstrated inflammation of the left optic nerve. Demyelinating disease was excluded through appropriate investigations. The close temporal relationship between botulinum toxin exposure and symptom onset, along with the absence of alternative etiologies, supported a diagnosis of toxin-related optic neuritis. This case highlights that intragastric botulinum toxin A may rarely precipitate optic nerve involvement and emphasizes the importance of patient counseling and prompt ophthalmologic assessment when visual symptoms occur.